Surgical Treatments for Fibroids

If you have moderate or severe symptoms of fibroids, surgery may be the best treatment for you.

Surgery can be a major procedure or a minor one. The type of surgery depends on the size, location, and number of fibroids present, and your desire to bear children in the future. Sometimes, there are a variety of surgical options to choose from. Talk to your health care provider about the different types of surgical treatments and about the possible risks, side effects, and recovery time of each procedure.

The current surgical treatments for fibroids are listed below.^1,2,3,4,5

• Uterine artery embolization (UAE)
• Endometrial ablation
• Magnetic resonance imaging (MRI)-guided ultrasound surgery
• Myomectomy
• Hysterectomy
• Robotic surgery

Uterine Artery Embolization (UAE)

Uterine artery embolization (pronounced YOO­ter­in AR-ter-ee em-bohl-ih-ZAY-shun), or UAE, is also called uterine fibroid embolization (UFE). This procedure cuts off the blood supply to the fibroids, causing them to shrink and be reabsorbed by your body.

In this procedure, the doctor makes a small cut in the groin area and inserts a tube (called a catheter) through the large blood vessel there. The doctor slides the tube until it reaches the arteries that supply blood to the uterus and then injects tiny particles through the tube into the arteries. The particles block blood flow to the fibroids. Blocking the blood flow eventually shrinks the fibroids and may relieve symptoms.

Recovery from UAE takes less time than does recovery from a hysterectomy. Some research has shown that UAE successfully treats fibroids but that about one-third of women who have UAE need treatment again within five years.¹

Because this procedure stops blood flow to parts of the uterus, it can affect how the uterus functions. Its effect on pregnancy is not clear, but an increased risk of miscarriage has been reported. For this reason, most health care providers do not recommend UAE for women who want to have children.

Endometrial Ablation

Endometrial ablation (pronounced en-doh-MEE-tree-ul ah-BLAY-shun) destroys the lining of the uterus. It is used to treat small fibroids inside the uterus. Two common ways of doing an ablation are with a heated balloon and with a tool that uses microwave energy to destroy the uterine lining and fibroids.

Pregnancy is unlikely after this procedure, but it can happen. Women who get pregnant after endometrial ablation are at higher risk for miscarriage and other problems. If you are going to have this treatment, talk to your health care provider about the risks of getting pregnant after the procedure. You might want to use birth control to prevent pregnancy until after you go through menopause.^6,7

Magnetic Resonance Imaging (MRI)­ Guided Ultrasound Surgery

This treatment destroys fibroids using high-intensity ultrasound. The health care provider uses an MRI scanner to see the fibroids, then directs ultrasound waves through the skin to destroy the fibroids. This option is usually recommended for women who have only a few large fibroids.

Scientists are still studying the long-term effects of this procedure.⁴ Current research shows that up to 25% of women who have MRI-guided ultrasound surgery need a second procedure after 1 year.⁵ Because MRI-guided ultrasound surgery is new, your health care provider may not offer it or your health insurance company may not pay for it.

Myomectomy

This procedure removes only the fibroids and leaves the healthy areas of the uterus intact. It can preserve your ability to get pregnant.

Myomectomy can be performed in one of three ways. The method you need will depend on the location and size of your fibroids.

• Hysteroscopy (pronounced hiss­tur­AH­skoh­pee). For this procedure, the surgeon inserts a long, thin telescope with a light through the vagina and cervix (the opening of the uterus). The doctor then uses electricity or a mechanical device to cut or destroy the fibroids. The doctor will inject a fluid into the uterus to make it easier to see before trying to remove the fibroids.
• Laparotomy (pronounced lap­are­AH­toh­mee). The surgeon removes the fibroids through a cut in the abdomen.
• Laparoscopy (pronounced lap­are­AH­skoh­pee). The surgeon uses a long, thin telescope to see inside the pelvic area, and then removes the fibroids using another tool. This procedure usually involves two small cuts in the abdomen.

Studies show that myomectomy can relieve fibroid-related symptoms in 80% to 90% percent of patients.² The original fibroids do not regrow after surgery, but new fibroids may develop.

Hysterectomy

In this procedure, the uterus is removed. Hysterectomy is the only sure way to cure uterine fibroids completely. Health care providers usually recommend this option if your fibroids are large, you have very heavy bleeding, and you are near or past menopause.

Sometimes the ovaries and fallopian tubes are removed along with the uterus. This procedure is called a total hysterectomy with bilateral salpingo-oophorectomy (pronounced bye-LATT-ur-el sal-PING-go ooh-for-EK-toh-mee).

There are several approaches to doing a hysterectomy:

• Abdominal hysterectomy. The surgeon removes the uterus through a cut in the abdomen. This incision may be similar to what is done during a cesarean section. Recovery time from an abdominal hysterectomy is one to two months.⁶ Removal of the ovaries is not required for treatment of fibroid symptoms. Similarly, some women may desire to preserve the cervix, if there is no history of abnormal pap smears.
• Vaginal hysterectomy. Instead of making a cut into the abdomen, the surgeon removes the uterus through the vagina. This method is less invasive than an abdominal hysterectomy, so recovery time is usually shorter. Vaginal hysterectomy may not be an option if your fibroids are very large.
• Laparoscopic hysterectomy. Minimally-invasive approaches may include laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, or robotic-assisted laparoscopic hysterectomy. Not all cases of uterine fibroids can be approached with such approaches, but these methods may result in reduced post-operative recovery time.

If you have not gone through menopause and are considering a hysterectomy for your fibroids, talk to your health care provider about keeping your ovaries. The ovaries make hormones that help maintain bone density and sexual health even if the uterus is removed. If your body can continue to make these hormones on its own, you might not need hormone replacement after the hysterectomy.

Having a hysterectomy means that you will no longer be able to get pregnant. Talk to your partner or spouse before deciding to have a hysterectomy. This process cannot be reversed, so be certain about your choice before having the surgery.

Robotic Surgery

Robotic surgery (robotic hysterectomy or myomectomy) is becoming increasingly common. Sitting at a console near the patient, the surgeon guides a robotic arm to perform laparoscopic surgery. Like laparoscopic myomectomies, robotic surgeries require only small incisions in the uterus and abdomen. As a result, recovery can be shorter with this type of surgery than with more invasive procedures. More research is needed to understand how (and how well) these procedures work and to compare the outcomes with those of other established surgical treatments.

1. Evans, P., & Brunsell, S. (2007). Uterine fibroid tumors: Diagnosis and treatment. American Family Physician 75(10), 1503-1508. [top]
2. Agency for Healthcare Research and Quality (AHRQ). (2005). The FIBROID Registry: Report of Structure, Methods, and Initial Results. (AHRQ Publication No. 05[06]-RG008). Retrieved from http://archive.ahrq.gov/research/fibroid/. [top]
3. Evans, P., & Brunsell, S. (2007). Uterine fibroid tumors: Diagnosis and treatment. American Family Physician 75(10), 1503-1508. [top]
4. American Congress of Obstetricians and Gynecologists (ACOG). (2009). Uterine fibroids. Retrieved from http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20121015T1425097855 (PDF - 366 KB). [top]
5. Berger, L. (2008, October 23). A Decade of Developments in Fibroid Research. New York Times. Retrieved from http://www.nytimes.com/ref/health/healthguide/esn-fibroids-expert.html. [top]
6. National Library of Medicine. (2011, January 11). Uterine fibroids. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000914.htm. [top]
7. Wallach, E. E., & Eisenberg, E. (2003). Hysterectomy, Exploring Your Options. The Johns Hopkins University Press: Baltimore, MD. [top]
8. Evans, P., & Brunsell, S. (2007). Uterine fibroid tumors: Diagnosis and treatment. American Family Physician 75(10), 1503-1508. [top]